What is the MultiPlan lawsuit? Attorney Matt Lavin exposes how commercial insurers allegedly use price fixing to underpay out-of-network healthcare claims.
Episode Resources
A single intermediary company touches an estimated 80% of all out-of-network medical claims in the United States, yet most doctors have never even heard of it. To help us understand the massive MultiPlan lawsuit, we sit down with Matt Lavin, a partner at Gilbert LLP and the lead antitrust attorney at the center of the battle. He breaks down how this obscure pricing system might be quietly draining hundreds of billions of dollars from American medicine.
Throughout the episode, Lavin explains the exact mechanics of how commercial health insurance companies process out-of-network claims and why the system is drawing scrutiny from the Department of Justice. He reveals how proprietary algorithms are allegedly used to aggressively suppress healthcare reimbursement rates, creating massive fees for insurers while leaving providers struggling and patients stuck with the balance. We also unpack the hub-and-spoke cartel theory that forms the foundation of this case, detailing the real-world financial impact on rural hospitals and private practices.
If you are an independent physician dealing with unpredictable revenue or a practice manager trying to make sense of mysteriously slashed payments, this episode is for you. You will walk away with a clear understanding of the hidden corporate forces driving down your revenue and practical advice on how to audit your past claims to protect your business.
About Matt Lavin:
Matt Lavin is a partner at Gilbert LLP’s Washington, D.C. office. He has successfully resolved countless reimbursement disputes with commercial payors such as Aetna, Anthem, AmeriHealth, Ambetter, Beacon, Centene, HealthNet, Humana, Cigna, UnitedHealthcare, HealthNet, Magellan, and many Blue Cross Blue Shield entities and Blue Card Network plans. Matt has experience with practically every aspect of the business of healthcare and revenue cycle management and has handled suits against “cost-containment” vendors, like MultiPlan, that egregiously underprice the value of out-of-network claims.